orthopaedic

Your ankle bone and the ends of your two lower leg bones make up the ankle joint. Your ligaments, which connect bones to one another, stabilize and support it. Your muscles and tendons move it.

The most common ankle problems are sprains and fractures (broken bones). A sprain is an injury to the ligaments. It may take a few weeks to many months to heal completely. A fracture is a break in a bone. You can also injure other parts of the ankle such as tendons, which join muscles to bone, and cartilage, which cushions your joints. Ankle sprains and fractures are common sports injuries.

Each of your feet has 26 bones, 33 joints, and more than 100 tendons, muscles, and ligaments. No wonder a lot of things can go wrong. Here are a few common problems:

• Bunions - hard, painful bumps on the big toe joint
• Corns and calluses - thickened skin from friction or pressure
• Plantar warts - warts on the soles of your feet
• Fallen arches - also called flat feet

Ill-fitting shoes often cause these problems. Aging and being overweight also increase your chances of having foot problems.

Your bones help you move, give you shape and support your body. They are living tissues that rebuild constantly throughout your life. During childhood and your teens, your body adds new bone faster than it removes old bone. After about age 20, you can lose bone faster than you make bone. To have strong bones when you are young, and to prevent bone loss when you are older, you need to get enough calcium, vitamin D, and exercise. You should also avoid smoking and drinking too much alcohol.

Bone diseases can make bones easy to break. Different kinds of bone problems include:

• Low bone density and osteoporosis, which make your bones weak and more likely to break
• Osteogenesis imperfecta makes your bones brittle
• Paget's disease of bone makes them weak
• Bones can also develop cancer and infections
• Other bone diseases, which are caused by poor nutrition, genetics, or problems with the rate of bone growth or rebuilding

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Deep vein thrombosis, or DVT, is a blood clot that forms in a vein deep in the body. Most deep vein clots occur in the lower leg or thigh. If the vein swells, the condition is called thrombophlebitis. A deep vein thrombosis can break loose and cause a serious problem in the lung, called a pulmonary embolism.

Sitting still for a long time can make you more likely to get a DVT. Some medicines and disorders that increase your risk for blood clots can also lead to DVTs. Common symptoms are :

• Warmth and tenderness over the vein
• Pain or swelling in the part of the body affected
• Skin redness

Treatment includes medicines to ease pain and inflammation, break up clots and keep new clots from forming. Keeping the affected area raised and applying moist heat can also help. If you are taking a long car or plane trip, take a break, walk or stretch your legs and drink plenty of liquids.

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes, your body doesn't make insulin. With type 2 diabetes, your body doesn't make or use insulin well. Without enough insulin, glucose can't get into your cells as quickly as usual. The glucose builds up in your blood and causes high blood sugar levels.

Foot problems are common in people with diabetes. They can happen over time when high blood sugar damages the nerves and blood vessels in the feet. The nerve damage, called diabetic neuropathy, can cause numbness, tingling, pain, or a loss of feeling in your feet.

If you can't feel pain, you may not know when you have a cut, blister, or ulcer (open sore) on your foot. A wound like that could get infected. The infection may not heal well because the damaged blood vessels can cause poor blood flow in your feet.

Having an infection and poor blood flow can lead to gangrene. That means the muscle, skin, and other tissues start to die. If you have gangrene or a foot ulcer that does not get better with treatment, you may need an amputation. This is a surgery to cut off your damaged toe, foot, or part of your leg. It may prevent a bad infection from spreading and could save your life.

But there's a lot you can do to prevent a foot wound from becoming a major health problem.

The best way to protect your feet is by controlling your blood sugar levels every day. This will help keep nerve and blood vessel damage from getting worse. The next step is to keep the skin of your feet healthy.

Good foot care for people with diabetes includes:

• Checking your feet every day. Look for cuts, redness, and other changes in the skin and toenails, including warts or other spots that your shoes could rub. Make sure to check the bottoms of your feet too.
• Washing your feet every day. Use warm water and soap. Don't soak your feet because that can dry out your skin. After you dry your feet, you can use talcum powder or cornstarch between your toes. They soak up moisture that can cause infection. If you use lotion, don't apply it between your toes.
• Asking your doctor how to remove corns and calluses safely. Thick skin on your feet can rub and lead to sores. But removing it the wrong way could damage your skin. So you don't want to cut the skin or use medicated pads or liquid removers.
• Trimming your toenails straight across with a clipper. If it's hard for you to trim your own toenails, or if they're thick or curve into the skin, have a podiatrist (foot doctor) do it for you.
• Always wearing well-fitting shoes and socks or slippers to protect your feet when walking. You don't want to walk barefoot, even indoors. And be sure your shoes are smooth inside. A seam or pebble could rub your skin raw.
• Protecting your feet from heat and cold. Use sunscreen on exposed skin and don't walk barefoot at the beach. In cold weather, wear warm socks instead of warming your feet near a heater or fireplace.
• Keeping the blood flowing in your feet. Put your feet up when you're sitting. Wiggle your toes and circle your feet throughout the day. Don't wear tight socks. And get plenty of activity that's not too hard on the feet, such as walking.
• Getting your feet checked at your health care visits. Even if you haven't noticed a problem, it's good to have your health care provider look at your feet.

Serious foot problems can develop quickly. See your health care provider right away if you notice:

• A cut, blister, or bruise on your feet that doesn't start to heal in a few days
• Red, warm, or painful skin on your feet
• A callus with dried blood inside
• A foot infection that becomes black and smells bad that could be gangrene

Remember, controlling your blood sugar and caring for your feet every day are the best steps you can take to prevent serious diabetic foot problems.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Each step you take involves a complex network of bones, muscles, tendons, and ligaments. This, combined with all of the weight they carry, explains why feet can have problems. To keep your feet healthy:

• Examine your feet regularly
• Wear comfortable shoes that fit
• Wash your feet daily with soap and lukewarm water
• Trim your toenails straight across and not too short

Your foot health can be a clue to your overall health. For example, joint stiffness could mean arthritis. Tingling or numbness could be a sign of diabetes. Swelling might indicate kidney disease, heart disease, or high blood pressure.

Good foot care and regular foot checks are an important part of your health care. If you have foot problems, be sure to talk to your doctor.

NIH: National Institute on Aging

Hip replacement is surgery for people with severe hip damage. The most common cause of damage is osteoarthritis. Osteoarthritis causes pain, swelling, and reduced motion in your joints. It can interfere with your daily activities. If other treatments such as physical therapy, pain medicines, and exercise haven't helped, hip replacement surgery might be an option for you.

During a hip replacement operation, the surgeon removes damaged cartilage and bone from your hip joint and replaces them with new, man-made parts.

A hip replacement can:

• Relieve pain
• Help your hip joint work better
• Improve walking and other movements

The most common problem after surgery is hip dislocation. Because a man-made hip is smaller than the original joint, the ball can come out of its socket. The surgery can also cause blood clots and infections. With a hip replacement, you might need to avoid certain activities, such as jogging and high-impact sports.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Your joints are places where two or more bones come together. Your shoulders, elbows, hips, knees, and knuckles are all joints. Your spine has joints, too.

But joints are more than bones. They include the soft tissues around them, such as cartilage, tendons and ligaments. Cartilage is the hard slippery flexible tissue that covers the ends of your bones at a joint. Tendons are tough, flexible bands that connect your muscles to your bones so you can move your joints. Ligaments connect the bones of the joint to each other to keep them stable when you move.

Joint disorders are diseases or injuries that affect your joints. Injuries can happen because of overuse of a joint. Or you could have a sudden injury, such as an accident or a sports injury.

Many diseases can affect the joints. They often cause joint pain and make your joints stiff, red, or swollen. Most of them are chronic. That means they last a long time. Some may never go away completely. Some of the diseases that affect the joints include:

• Arthritis. Arthritis may cause joint pain and swelling. There are many types of this disease. Osteoarthritis is the most common type. Over time, arthritis can cause severe joint damage. It can affect people of all ages. A joint injury when you're young may cause osteoarthritis later in life.
• Lupus. This autoimmune disease affects many parts of the body and can cause joint and muscle pain. Some types of lupus often cause arthritis.
• Sjögren's Syndrome. This autoimmune disease affects glands that make moisture in many parts of the body. The main symptoms are dry eyes and mouth, but it often causes joint pain, too.

Treatments are different depending on the disease. But most treatments include medicines and therapies to relieve pain and other symptoms.

Joint disorders from sudden injuries include:

• Sprains and strains. Sprains are stretched or torn ligaments. Acute strains are stretched or torn muscles or tendons that happen from a sudden injury or movement, such as lifting a heavy object.
• Dislocated joints. A joint is dislocated when the bones are pushed or pulled out of position. A joint dislocation is a medical emergency.

Treatment depends on the type of injury. You can treat many sports injuries at home. But you should call your health care provider if you:

• Have a lot of joint pain, swelling or numbness
• Can't put weight on the joint
• Have pain from an old injury with more swelling, an unstable joint, or a joint that isn't normal in another way

Overuse injuries usually damage the soft tissues of the joint. They can happen when you work a joint too hard by doing the same movements over and over. For example, you could get an overuse injury from playing a musical instrument, playing sports, or doing certain jobs, such as carpentry or painting.

Joint overuse injuries include:

• Bursitis. The bursa is a small fluid-filled sac. It works as a pad between the bones of a joint and the moving parts around it, such as muscles, tendons and skin. With bursitis, the bursa becomes irritated and swollen with extra fluid. Overuse is the most common cause, but injuries, infections and other conditions, such as arthritis, can cause bursitis.
• Tendinitis. This condition happens when you overuse a tendon. It swells and makes the joint painful to move.
• Chronic strain. A strain becomes chronic when your muscles or tendons stretch or tear slowly over time from repeating the same movements.

The treatments for bursitis, tendinitis, and chronic strain are often the same. They usually include rest, keeping the injured joint higher than your heart, and taking medicine to reduce swelling. Your provider may recommend gentle exercise and other treatment. In some cases, your provider may suggest an injection (a shot) of medicine into the joint. If these do not help, you may need surgery.

Getting enough physical activity is one of the most important things you can do to prevent or slow joint disorders. Activity strengthens the muscles around your joints and helps them work better.

When you play sports, wear the right equipment to protect your joints, such as knee pads. If you already have joint problems, ask your provider what type of activities are best for you.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Knee replacement surgery is a surgery to replace parts of your knee joint with new, artificial parts. You may need a knee replacement if you have knee damage that causes severe pain and difficulty doing daily activities, such as walking and climbing stairs. It is usually done when other treatments for knee pain haven't helped enough. The goal of a knee replacement is to relieve pain and help you move better.

People of all ages may have knee replacement surgery. But it is more common in older people. The decision whether to have surgery is based on your overall health and how much your knee bothers you.

Knee replacement surgery treats conditions that cause the cartilage of the knee joint to wear away. These include:

• Knee osteoarthritis. This is the most common reason for knee replacement surgery. It usually develops over time after an injury or with aging.
• Knee damage from other types of arthritis.
• Problems from knee joints that aren't formed correctly.

During the surgery, a surgeon removes damaged cartilage and some bone from the surfaces of your knee joint. Cartilage is tissue that covers your bones where they meet. Healthy cartilage is smooth and helps the bones glide over each other when you move. When cartilage becomes rough and wears away, the bones rub against each other, causing pain.

After removing the damaged knee cartilage and bone, the surgeon attaches the artificial parts to your bones. The artificial parts are made of metal and plastic. They will give your knee new, smooth surfaces.

Knee replacement surgery may replace all the damaged parts of your knee (total knee replacement) or just part of your knee (partial knee replacement). In a total knee replacement, the surgeon replaces 3 surfaces:

• The end of the shinbone
• The end of the thighbone
• The back of the kneecap

Some people go home the same day they have surgery. Other people will stay in the hospital a few days. To help prevent blood clots, you'll most likely take blood thinners and wear special socks or coverings on your legs for a short time after surgery.

The success of your surgery depends a lot on what you do at home to help yourself recover. A physical therapist will teach you exercises to make your knee stronger and help it bend. It is important to do these exercises regularly. You may need to use a cane or walker for several weeks after the surgery. It will probably also be several weeks before you can drive. Your doctor will tell you when you can start driving again.

Most people who follow their recovery instructions can get back to nearly all of their normal daily activities within 3 to 6 weeks after surgery.

After recovering from surgery, most people can move better with less pain than before surgery. But having an artificial knee is not the same as having a normal, healthy knee.

You need to protect your new knee by:

• Staying at a healthy weight.
• Getting regular physical activity.
• Not doing any high-impact activities, such as jogging, running, and jumping. Instead, you can try low-impact activities that are good for your knee, such as walking, biking, and swimming

The chance of having problems after knee replacement surgery is low. But there are risks after any surgery. Possible problems after knee replacement surgery include:

• Infection
• Blood clots
• Heart attack
• Stroke
• Nerve damage
• Scarring that limits how far you can bend your knee

Your age, general health, and how active you are can all affect your risk of having a problem after knee replacement surgery.

A knee replacement doesn't last forever. After 15 to 20 years, the artificial knee parts may become loose or worn. If that happens, you may need another surgery on the same knee.

If you're thinking about having knee replacement surgery, talk to your doctor about the risks and benefits. Together you can decide if a knee replacement is right for you.

Your muscles help you move and help your body work. Different types of muscles have different jobs. There are many problems that can affect muscles. Muscle disorders can cause weakness, pain or even paralysis.

Causes of muscle disorders include:

• Injury or overuse, such as sprains or strains, cramps or tendinitis
• A genetic disorder, such as muscular dystrophy
• Some cancers
• Inflammation, such as myositis
• Diseases of nerves that affect muscles
• Infections
• Certain medicines

Sometimes the cause of muscle disorders is unknown.